Insulin Resistance, 2008 Childhood Precursors and Adult Disease Contemporary Endocrinology Series

In the mid 1990s, Drs. Gerald Reaven identified a constellation of clinical findings, known variously as the metabolic syndrome, syndrome X, insulin resistance s- drome or insulin resistance-related disorders, that are associated with an increased risk of heart disease and diabetes. Interest in this topic grew rapidly, culminating in the publication by this series of the book, Insulin Resistance and the Metabolic Syndrome X, edited by Drs. Reaven and Laws in 1999. Since the original publication of that now classic volume, the world?s population has continued to become more obese and sedentary and the prevalence of disorders related to insulin resistance has continued to increase throughout the developed and developing world. Of great concern in the last decade is the extension of these deleterious lifestyle patterns to the pediatric population, leading to both obesity and the appearance of insulin resistance-related disorders in youth as well as adults. Today, about one in three children and adolescents in the United States is overweight or obese, and this prevalence approaches one in two among adolescents in certain minority groups. In addition, components of this cardiovascular risk constellation are now being recognized in young adults, adolescents, and even children. Youth are increasingly developing type 2 diabetes, fatty liver disease, hypertriglyceridemia, hypertension, polycystic ovarian syndrome, sleep apnea, orthopedic and psychiatric complications, as well as other complications of obesity and insulin resistance.

Epidemiology.- The Metabolic Syndrome: Definitions, Controversies and Clinical Utility.- Epidemiology of the Metabolic Syndrome and Related Disorders in Children and Adolescents.- Metabolic Syndrome in Children and Adolescents Worldwide.- Maternal-Fetal Contributors to the Insulin Resistance Syndrome in Youth.- Early Childhood Contributions to Insulin Resistance.- Pathophysiology.- Molecular Mechanisms of Insulin Resistance.- Techniques Used to Assess Insulin Action.- Adiposity is The Enemy: Body Composition and Insulin Sensitivity.- Ectopic Fat Deposition, Adiponectin and Insulin Resistance in Obese Adolescents.- Mediators of Insulin Resistance.- Insulin Resistance and the Pathogenesis of Cardiovascular Disease.- Insulin Resistance and Cardiovascular Disease.- The Liver and Insulin Resistance: The Important Convergence of Endocrinology and Hepatology.- Polycystic Ovary Syndrome and Metabolic Syndrome.- Treatment.- Effects of Exercise in Metabolic Syndrome and Diabetes: A Central Role for Insulin Sensitivity.- Weight Loss Medications and the Metabolic Syndrome.

State-of-the-art perspective on insulin resistance by renowned experts in the field Topics cover insulin resistance and its consequences across the lifespan Reviews controversies over the definition of metabolic syndrome in adults and children Addresses current knowledge regarding the epidemiology of insulin resistance in the pediatric population Examines views on prenatal and early childhood environment to the development of insulin resistance Explores pathophysiology, with reviews of the techniques used to study insulin resistance Provides an overview of current knowledge of the molecular and physiologic mechanisms of insulin resistance, including the contributions of adipose tissue and biochemical mediators Discusses the relationship between insulin resistance and cardiovascular, endothelial, liver and gonadal disorders Explores the impact of exercise and weight loss medications on insulin resistance